Tag Archives: E Cigarettes

Dr. Hongying Dai, PhD
Associate Professor at the College of Public Health
University of Nebraska Medical Center.

MedicalResearch.com: What is the background for this study?

Response: The 2009 Family Smoking Prevention and Tobacco Control Act (FSPTCA) banned cigarettes with characterizing flavors (e.g., candy, fruit, clove) except menthol. However, there are no restrictions on the marketing and sales of flavored non-cigarette tobacco products. This has led to a proliferation of flavored tobacco products in the marketplace. Flavoring has become one of the leading reasons for current tobacco use among youth. It is reported that 81% of e-cigarette users, 79% of hookah users, 74% of cigar users, 69% of smokeless tobacco users, and 67% of snus users attributed the availability of appealing flavors for their tobacco use in 2013–2014 among teenagers aged 12 to 17 years. In November 2018, the FDA proposed new restrictions on flavored tobacco products.

Response: E-cigarettes were introduced first in US market as a less harmful method of nicotine delivery which potentially would help smokers to have a less harmful option.

However, overtime e-cigarette found its niche of consumers in the younger/tobacco naïve population. Our study is amongst the first studies that describes those who use e-cigarette without any history of combustible-cigarette smoking.Continue reading →

MedicalResearch.com Interview with:Brian King, PhD
Lead author and Deputy Director for Research Translation
Office on Smoking and Health.
CDC

MedicalResearch.com: What is the background for this study?

Response: Since first entering the U.S. marketplace in 2007, e-cigarettes have been a rapidly evolving product class. Typically, national surveys provide annual, self-reported estimates of e-cigarette use among adults and youth. However, given the dynamic nature of the e-cigarettes landscape, data collected at a sub-annual level can be useful for identifying rapid changes and patterns. For example, retail sales data, which is available at more frequent intervals, such as weekly, can complement annual surveys and help keep a pulse on emerging trends. This study assessed e-cigarette retail sales data in the United States from 2013 through 2017.

Response: Many people think that it’s the nicotine that’s harmful so they opt for using a low strength in their e-liquid. We know from tobacco smoking that when people switch to using a lower nicotine yield cigarette, they compensate in order to maintain a steady blood nicotine level by taking longer, harder drags and this can increase exposure to toxins in the smoke. We also know from some of our other work with vapers (e-cigarette users) that they tend to reduce the nicotine strength of their e-liquid over time. We therefore wanted to explore whether vapers also engage in this compensatory puffing and whether this has any effect on exposure to potentially harmful chemicals.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: To date most studies on e-cigs have either looked at the product itself, i.e. analysed vapour/aerosol or e-liquid, or investigated its effects on animal and cell models. Only very few studies have looked at actual body-level exposure in users of e-cigarettes to evaluate their safety, and this study is the first to explore this in long-term real-life users of e-cigs.

We find that compared with people who continue to smoke conventional cigarettes, those who switch over completely to using e-cigarettes long-term (1.5 years) dramatically reduce their exposure to cancer-causing chemicals to levels observed in users of nicotine replacement products like nicotine patch or gum (which are known to be safe when used long-term).

Our results also suggest that while e-cigarettes are not only safer, the amount of nicotine they provide is not noticeably different to conventional cigarettes. This can help people to stop smoking altogether by dealing with their cravings in a safer way.

MedicalResearch.com: What should readers take away from your report?

Response: The public has been receiving very mixed signals about the safety of e-cigarettes, with some reports claiming to show that they are as harmful as smoking. These reports have been based on studies that bear little relationship to exposure of e-cigarette users in the real world.

We report the first study that has actually measured the intake of potentially harmful chemicals in e-cigarette users, and compared this with people using licensed nicotine products (e.g. nicotine patches), and cigarettes. This study should reassure smokers who are thinking of switching to an e-cigarette that if they manage to cut out cigarettes altogether, they should see a large benefit in terms of their health.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: The next step would be would be to follow smokers over a longer period of time who switch over to using e-cigarettes and measure potential harm and risks not only in relation to cancer but also lung function and cardiovascular health.

MedicalResearch.com: Is there anything else you would like to add?

Response: None of the other authors have received funding from an e-cigarette company or any organisation acting for one.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We have previously identified several ingredients in e-cigarettes that may be potentially dangerous to users. The long-health effects of inhaling aerosol from e-cigarettes is currently unknown and we are looking for alternative ways to test the products safety. We have noticed previously that various brands and types of e-cigarettes differ in the toxicant levels and their potential toxic effects. So we systematically evaluated various product features and we were able to identify device power and flavoring additives as key components that significantly affect the potential toxicity of e-cigarettes. Interestingly, it was not nicotine or nicotine solvents but other additives in e-cigarettes that affected respiratory cells used in our study.

Medical Research: What is the background for this study? What are the main findings?Dr. Goniewicz: In addition to nicotine and its solvents (like propylene glycol and vegetable glycerin), a majority of e-cigarettes contain flavorings. Users of e-cigarettes can choose their favorite flavor among hundreds of various options, including fruit, coffee, menthol, vanilla, chocolate, candy flavors, and tobacco. Although many flavorings used in e-cigarettes are recognized as safe when used in food products, little is known about their potential toxicity when inhaled.

In this study we measured one such flavoring, benzaldehyde. This flavoring is commonly used in food and cosmetics. We know that there is little to no toxicity if we eat this compound or if we apply it on our skin. However, workers who regularly inhale a high concentration of benzaldehyde often report irritation of their eyes and throat. In this study, we tested 145 e-cigarette products, and we found benzaldehyde in 108 products. Interestingly, the highest levels of benzaldehyde were detected in cherry-flavored products.Continue reading →

Dr. Williams: In recent years, the e-cigarette industry has ballooned into a multi-billion dollar market, with at least 466 brands and 7764 unique flavors of e-cigarettes sold online. With both smokers and people who never smoked turning to e-cigarettes, there are concerns about their safety, lack of regulation and accessibility to teens. The CDC reported that 17% of high school seniors use e-cigarettes, more than twice as many as use traditional cigarettes; furthermore, that hundreds of thousands of youth annually are using e-cigarettes who never smoked cigarettes.

Our previous studies of Internet cigarette sales indicated that Internet Tobacco Vendors did a poor job of preventing sales to minors, which helped inform development of state and federal regulations to regulate such sales. In 2013, North Carolina passed a law requiring age verification for online e-cigarette sales. This study was the first study to examine age verification used by Internet e-cigarette vendors and the first to assess compliance with North Carolina’s e-cigarette age verification law.

MedicalResearch: What are the main findings?

Dr. Williams: It was very easy for minors to buy e-cigarettes online. It took little effort for them to bypass the age verification practices of the vendors because there was very little use of rigorous age verification. With only 5 orders rejected by vendors due to age verification, there was a youth e-cigarette purchase success rate of 94.7%. No vendors used age verification at delivery, and few used rigorous methods of age verification that could potentially block youth access. While 7 vendors claimed to use age verification techniques that could potentially comply with North Carolina’s law, only one actually did.

Dr. Ling: We followed a sample of smokers from a nationally representative panel for one year. We found that there was no difference in the rate of quitting between smokers who used an e-cigarette and those who did not. Put another way, smokers who had used e-cigarettes at the beginning of the study were equally likely to have quit smoking one year later as those who did not use e-cigarettes. There was no relationship between e-cigarette use and quitting even after taking into account measures of tobacco dependence (number of cigarettes smoked per day, how early in the day a smoker has his first cigarette) and intention to quit smoking.

Answer:Middle and high school students who used e-cigarettes were more likely to smoke tobacco cigarettes. They were also more likely to progress from experimenting with tobacco cigarettes to becoming regular smokers.

Teen smokers who used e-cigarettes were more likely to be planning to quit in the next year and less likely to have abstained from smoking recently, compared to smokers who had never used e-cigarettes. They were also more likely to be heavier smokers (smoke more cigarettes per day) than those who had never tried e-cigarettes, that being said there are eliquids available that have no nicotine content whatsoever and these are therefore a much healthier option, you can see a wide variety of these at Gourmet E-Liquid.Continue reading →

MedicalResearch.com Interview with:

Dr. Chris Bullen MBChB MPH PhD FAFPM FNZCPHM Director
School of Population Health, The University of Auckland
Private Bag 92019 Auckland 1142, New Zealand
Co-Director of the NZ Tobacco Control Research Turanga: A national programme of research to inform rapid smoking prevalence reduction.
Web: http://www.turanga.org.nz/

MedicalResearch.com: What are the main findings of the study?

Dr. Bullen:

E-cigarettes, with or without nicotine, were modestly effective at helping smokers to quit, with similar levels of abstinence as with nicotine patches, and few adverse events.

At 6 months, verified abstinence was 7·3% with nicotine e-cigarettes, 5·8% with patches, and 4·1% with placebo e-cigarettes. However, there was insufficient statistical power to conclude superiority of nicotine e-cigarettes to patches or to placebo e-cigarettes.

No significant differences in rates of adverse events occurrence were found between the groups.

E-cigarettes were very popular throughout the trial, with almost 90% of users stating they would recommend them to a friend trying to quit smoking.

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